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Knee Arthroplasty
Knee Arthroplasty
HISTORY
The first artificial implants were tried in the
1940s
KNEE ARTHROPLASTY Next decade tibial replacement was attempted
problems with loosening and persistent pain.
Combined femoral and tibial articular surface
replacements appeared in the 1950s as simple
hinges → failed to account for the
complexities of knee motion and consequently
had high failure rates.
HISTORY HISTORY
GUNSTON (1971) – recognized that the The Total Condylar prosthesis was
knee does not rotate on a single axis designed in 1973
like a hinge but rather the femoral Concentrated on mechanics and did not try
condyles roll and glide on the tibia and reproduce normal knee motion
with multiple instant centers of Subsequently altered to artificially
rotation. introduce normal kinematics to improve
ROM of the component
Relying on the retained cruciates to
provide knee motion.
HISTORY DEFINITION
The argument as to whether knee ligaments Patients with painful, deformed
should be preserved or sacrificed goes on to
and unstable knees secondary to
this day
degenerative or inflammatory
Long term follow up studies do not show conditions need a prosthesis →
any significant differences although gait
appears to more normal if ligaments are
provide relief of pain and
preserved, especially when walking up and improvement in function
down the stairs.
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ETIOLOGY
FREQUENCY Osteoarthritic destruction of the knee is the commonest
reason for total knee replacement
Disease of synovial joints characterized by degenerative
Approximately 130,000 knee and reparative process
May be primary or secondary
replacements are performed Mechanical derangement such as previous meniscal or
every year in the USA cruciate ligament damage, pyogenic infection, ligamentous
instability, and fracture into a joint are among the common
causes of the secondary type
Other causes of include RA, hemophilia, the zero negative
arthritides, crystal deposition diseases, pigmented
villonodular synovitis, avascular necrosis and the rare bone
dsyplasias.
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INDICATIONS INDICATIONS
The primary indication for total knee Correction of significant deformity –
arthroplasty is to relieve pain caused by important indication but is rarely used as
severe arthritis the primary indication of surgery
X-RAY FINDINGS → clear clinical impression
Pain should be significant and disabling of knee arthritis
causing significant reduction in the
patient’s quality of life then this should be All conservative treatment measures
taken into account. should have been exhausted
CONTRAINDICATIONS CONTRAINDICATIONS
ABSOLUTE CONTRAINDICATIONS: RELATIVE CONTRAINDICATIONS:
– knee sepsis, previous osteomyelitis, a remote
source if ongoing infection, extensor – Medical conditions that preclude safe
mechanism dysfunction, severe vascular anesthesia, the demands of surgery and
disease, recurvatum deformity secondary to rehabilitation. Other relative contraindications
muscular weakness, and the presence of a include skin condtions within field of surgery
well functioning knee arthrodesis. e.g psoriasis, a neuropathic joint and obesity.
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COMPLICATIONS COMPLICATIONS
INFECTION PATELLOFEMORAL COMPLICATIONS
– Include patellofemoral instability, patellar
– Prevention intercurrent infection fracture, patellar component failure,
patellar clunk syndrome, and extensor
– Prophylactic antibiotics, UV light, body
mechanism tendon rupture.
exhaust systems to prevent bacterial
shedding and meticulous and expeditious – Common reasons for re-operation
surgery → reduce infection to less than 1% – Can be avoided by attention to detail,
of operations. meticulous technique and the avoidance of
component malposition.
COMPLICATIONS COMPLICATIONS
NEUROVASCULAR COMPLICATIONS: NEUROVASCULAR COMPLICATION:
– It usually occurs in the correction of
– Arterial thrombosis after TKR is rare but
combined fixed valgus and flexion
devastating complication, frequently
deformities, as are often seen in px’s
resulting in amputation.
with RA.
– Peroneal nerve palsy is the common
– Some good results have been obtained
reported nerve palsy after TKR.
with surgical decompression.
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COMPLICATIONS
PERIPROSTHETIC FRACTURES:
– Supracondylar fractures of the femur →
not common after TKR.
– Seen if the ant. Femoral cortex is notched
and weakened during surgery and in ox’s
with osteoporosis, RA, poor flexion, revision
arthroplasty, and in neurological disorders
– Treatment is with internal fixation or
revision TKA. Tibial fractures are
uncommon.